膵管空腸吻合術後残存膵石の消失がみられたアルコール性膵炎の1例

A Case of Chronic Alcoholic Pancreatitis with Progressive Disappearance of Residual Pancreatic Calculi after Pancreaticojejunostomy

症例

　患　者：膵石症　680357，52歳　男

　家族歴：特記すべきものなし

　既往歴：30歳台にマラリアに罹患した他は特記すべきものなし

　現病歴：20歳台より毎日日本酒5合～1升摂取．10年前に飲酒後腹部鈍痛が出現し，他施設に入院膵疾患と診断されたが，このとき膵石は認められていない．2年後および5年後に同様の腹痛があり，糖尿病といわれている．入院半年前より飲酒あるいは食事摂取後頻回に上腹部痛が出現するようになり，膵石を発見された．2カ月前より腹痛は激烈となり食事摂取はほとんど不可能となる．この間，黄疸，発熱，下痢は認められていない．

　A man aged 52 was admitted complaining of severe upper abdominal pain. He had been drinking one to two liters of sake per day for more than 30 years. There was no other relevant personal or family history.

　On admission, roentogenography of the abdomen showed numerous small calculi throughout the pancreas. Pancreozymin-secretin test confirmed total secretory deficiency of exocrine function. Fasting blood glucose was within normal limit. However, following oral glucose torelance test, blood glucose curve was diabetic and marked reduction in insulin response was observed.

　At operation, gross examination and operative pancreatography revealed diffuse scarring of the pancreas with slightly dilated main duct and many small calculi.

　The patient underwent pancreaticojejunostomy (Puestow's procedure) with removal of the spleen and tail of the pancreas. Microscopically, the resected specimen of the pancreas showed severe fibrosis with almost complete loss of exocrine parenchyma. The patient suffered from left subphrenic abscess ten months later, but otherwise had an uneventful postoperative course.

　Since five years after operation, the patient began again to drink a large amount of sake, but clinically he asymptomatic. Five to six years after operation, roentgenography of the abdomen revealed progressive disappearance of calculi remaining in the head of the pancreas, although the diabetic state became worse requiring oral treatment.